What is an out-of-network benefit?

An out-of-network benefit is a type of health insurance coverage that allows you to receive coverage for services that are not provided by a network of providers. This means that if you visit a doctor, hospital, or other health care provider who is not part of your insurer’s network, you may still receive coverage. In Washington, this type of coverage is regulated by the Office of the Insurance Commissioner (OIC). The OIC sets rules that all out-of-network benefits must follow, such as the types of services that must be covered and the maximum amount that the insurer will pay for a service. This type of benefit is important because it provides coverage when an in-network provider is not available or when the services provided by an in-network provider may be more expensive than an out-of-network provider. In addition to providing coverage for services that are not available within a network, some out-of-network benefits will cover certain costs associated with certain services, such as copayments and deductibles for certain services. Out-of-network benefits can provide a lot of flexibility and be very helpful for those who need to access healthcare services that are not available within an in-network provider. However, it is important to remember that out-of-network benefits may not cover all services, so it is important to familiarize yourself with the coverage provided by your insurer and any out-of-network benefits that may be available to you.

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